LECTURE 14 (Leopold manoeuvre) Flashcards
What is the importance of the Leopold manoeuvre?
- Used to palpate the gravid uterus systematically
- Low cost, easy to perform and non-invasive
- Used to determine the position, presentation and engagement of foetus in uterus
What is the aim of Leopold manoeuvres?
To determine the foetal presentation and position by systematically palpating the gravid abdomen
What is foetal presentation?
The foetal anatomic part proceeding first into the pelvic inlet. When the foetal head is approaching the pelvic inlet, it is referred to as “Cephalic presentation” (normal presentation)
ADDITIONAL INFO: Malpresentations are the breech position, transverse and oblique lie
What are the indications and contraindications for Leopald manoeuvre?
INDICATIONS
- To determine the position of the foetus inside the woman’s uterus
- Accurate assessment of foetal presentation + position is crucial in guiding obstetric management (etc if a cesarean is needed)
CONTRAINDICATIONS
- Evaluation of presentation by abdominal palpation before 36 weeks
- Complicated manoeuvres to perform on obese women + women who have polyhydramnios
What part of the abdomen should be exposed on the patient during the manoeuvre?
From the xiphisternum to the pubic symphysis
What question do each of the manoeuvres answer?
- FIRST MANOEUVRE: What foetal part occupies the fundus?
- SECOND MANOEUVRE: On what side is the foetal back?
- THIRD MANOEUVRE: What foetal part lies over the pelvic inlet?
- FOURTH MANOEUVRE: On which side is the cephalic prominence?
Describe the first manoeuvre
- Assesses the uterine fundus (if it’s head or bum)
- The breech gives the sensation of a large, nodular mass whereas the head feels hard and round + is more mobile
Describe the second manoeuvre
- Palms are places on either side of maternal abdomen + gentle pressure exerted
- On one side -> hard, resistant structure is felt “the back”, on other side -> numerous small, irregular, mobile parts are felt “foetal extremities”
Describe the third manoeuvre
- Thumb and fingers of one hand grasp the lower portion of the maternal abdomen just above pubic symphysis
- Head should be felt
Describe the fourth manoeuvre
- Helps determine degree of descent
- Examiner faces mother’s feet + finger tips of both hands are positioned on either side of presenting part
What is “Lie”?
Lie describes the relation of the long axis of the foetus to that of the mother. A longitudinal lie can be vertex (head first) or breech (buttocks first).
ADDITIONAL INFO: Lie can also be transverse of oblique
What is “Presentation/Presenting part”?
It describes the position of the foetus that is foremost within the birth canal + is determined by palpating through the cervix on vaginal examination.
- If lie is longitudinal -> presentation is either head, buttocks, brow or face
- If lie is transverse -> presentation is shoulder, back or abdomen
What is “Position”?
Position refers to the relation of the presenting part to the right (R) or left (L) side of the birth canal and its direction anteriorly, transversely or posteriorly
What is fundal height and its importance?
Fundal height is the distance between pregnant woman’s pubic bone and the top of her uterus
IMPORTANCE:
- assess if foetus is developing correctly
- helps determine gestational age + foetus’ position in uterus
- measured in cm with measuring tape
[after 20 weeks, fundal height is close to foetus’ gestational age -> e.g 24cm so woman is 24 weeks pregnant]
How do you estimate foetal birth weight?
The index of symphysis-fundal height and abdominal circumference
CLINICAL CORRELATION: Index has great potential for use in predicting macrosomia in normal pregnancies and GDM pregnancies
